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Painkillers

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Heroin 1
Source: DEA

Pain Killers 2
Actual photo of droopy eyes due to opioid use. Source: California Highway Patrol

Heroin 2
Heroin users often have “pinned” or constricted pupils that do not respond to poor lighting. Other depressants often have similar effects.

QUICK FACTS – PAIN KILLER ADDICTION

Commercial and Street Names

The following products are also known as opioid pain relievers:

1. Codeine (222®, 292®, Tylenol with Codeine®, Benylin Codeine3.3 mg-D-E®) (available as tablets, capsules, elixirs, suppositories, and solutions)

2. Morphine MS-Contin®, Oramorph SR®, MSIR®, Roxanol®, Kadian®, RMS®
(available as a solution for injection, tablets, and suppositories)

Street terms include C & M (cocaine & morphine), cotton brothers (cocaine, heroin and morphine), dreamer, emsel, firstine, god’s drug, hows, M, MS, Miss Emma, Mister Blue, morf, morpho, new jack swing, unkie (*).

Source: White House ONDCP

3. Meperidine or Pethidine Demerol® (available as tablets and injectable solutions) Hydromorphone Dilaudid® (available is tablets, suppositories, injectable solution, and oral liquid)

4. Hydrocodone Novahistex DH®, Novahistine DH®, Vicodin® (vikes)
(available as an ingredient of syrups for oral administration, and as tablets)

5. OxycodoneOxyContin®(killers, hillbilly heroin, OXY, oxycotton), Percodan® (percs). Sober Recovery has a longer list of street terms for Oxycontin®.

For more information that is specific to Oxycontin. see the Oxycontin section.

6. Pentazocine Talwin®

7. Butalbital with Codeine, ASA and Caffeine Fiorinal-C®

8. Methadone Dolophine®, dollies

For more information see the Methadone section.

9. Fentanyl Duragesic®, Actiq®, lethal injection, drop dead, fat Albert,
the bomb, incredible hulk. The White House has a longer list of  street terms for Fentanyl.

Used extensively for anaesthesia and analgesia. Duragesic® is a transdermal patch used in chronic pain management. Actiq® is intended for opiate-tolerant individuals and is effective in treating breakthrough pain in cancer patients. Carfentanil (Wildnil®) is used in veterinary practice to immobilize certain large animals. May also be smoked or snorted.

Description of Pain Killers

Opioids are commonly prescribed as pain relievers. Sometimes referred to as narcotics, opioids effectively change the way a person experiences pain. Morphine is often used before or after surgery to alleviate severe pain. Codeine is used for milder pain and as a cough suppressant. Other examples of opioids that are often prescribed include oxycodone (OxyContin – an oral, controlled release form of the drug); hydrocodone (Vicodin – taken orally); hydromorphone (Dilaudid – a long-acting painkiller); and meperidine (Demerol) which is also used before and after surgery but less often because of its side effects. Pentazocine produces similar effects to oxycodone. When abused, prescription pain relievers in tablet form are crushed to remove the sustained-release coating.

Fentanyl is used extensively for anaesthesia and analgesia. Duragesic® is a transdermal patch used in chronic pain management. Actiq® is intended for opiate-tolerant individuals and is effective in treating breakthrough pain in cancer patients. Carfentanil (Wildnil®) is used in veterinary practice to immobilize certain large animals. May also be smoked or snorted. This allows for a rapid release of the medication, causing a rush of euphoria similar to heroin. Crushed tablets can be used orally, sniffed or dissolved in water and injected.

Effects of Pain Killers

At low doses, effects include dizziness, drowsiness, droopy eyelids, impaired concentration, nausea, and slowed breathing. With large doses, pupils constrict to pinpoints, the skin is cold, moist, bluish, and breathing may slow to a complete stop, resulting in death. When these drugs are injected intravenously, there is a surge of pleasure that surpasses hunger, pain, and sexual urges. Taken orally, the effects are felt more gradually.

Long-term effects include severe constipation, constricted pupils, moodiness and menstrual irregularities. These symptoms disappear after the drug is no longer taken.

Tolerance develops fairly rapidly, making higher doses necessary to maintain intensity of effects. Regular use my result in physical dependence. Withdrawal symptoms include severe anxiety, insomnia, muscle and bone pain, diarrhea, vomiting, profuse sweating, tremors, cold flashes with goose bumps (“cold turkey”), kicking movements (“kicking the habit”), and other symptoms. These symptoms can occur four to five hours after last dose. The acute symptoms reach peak intensity after 36 to 72 hours and are usually over within 7 to 10 days. Opioid dependence increases the risk for miscarriage, premature labour, and low birthweight.

Sources: DEA; NIDA InfoFacts, Pain Medications and Other Prescription
Drugs, June 2006

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RESOURCES

I. PRINT RESOURCES – PAIN KILLER ADDICTION

For additional printed resources on pain killers see the Prescription Drug section.

Printed Resources – General Reading on Pain Killers

Addiction by Prescription: One Woman's Triumph Over Prescription Drugs and Addiction (2000) Joan Gadsby

I'm Dancing as Fast as I Can (1981) Barbara Gordon

Pain Killer: A "wonder" Drug's Trail of Addiction and Death(2003) takes readers on a journey of discovery that begins with the true story of Lindsay, a high-school cheerleader in Virginia who gets hooked on Oxys, and expands outward to explore the critical issues of legitimate pain management, prescription drug abuse, and how the misuse of science by the drug industry threatens the public good. Barry Meier.

Painkillers: Prescription Dependency(2008) Ida J. Walker

When Painkillers Become Dangerous: What Everyone Needs to Know About OxyContin and Other Prescription Drugs(2004) Drew Pinsky 

Printed Resources – Research on Pain Killers

The Neurobiology of Opiates provides a description of the effects of opiates on the central nervous system of developing and adult animals. Ronald P. Hammer.

For more information on addiction research see the Addiction Research section.

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II. ONLINE RESOURCES – PAIN KILLER ADDICTION

For additional online resources on pain killers see the Prescription Drug section.

General Information on Pain Killer Addiction

Do You Know ... Opioids? (2003) Centre for Addiction and Mental Health (CAMH).

Online Resources - Crime and Pain Killer Addiction

Promoting Pain Relief and Preventing Abuse of Pain Medications: A Critical Balancing Act is a consensus statement of health care community and law enforcement personnel.

Refer to the Oxycontin section for specific information on this particular type of pain killer.

Online Resources - Dilaudid and Pain Killer Addiction

See the Meperidine section.

Online Resources - Fentanyl and Pain Killer Addiction

Fentanyl (2011) Drug Enforcement Administration.

Online Resources - Hydrocodone and Pain Killer Addiction

Hydrocodone (2011) Drug Enforcement Administration.

Online Resources - Hydromorphone and Pain Killer Addiction

See the Meperidine section below.

Online Resources - Meperidine and Pain Killer Addiction

Hydromorphone (2010) Drug Enforcement Administration.

Online Resources - Nalbuphine Hydrochloride and Pain Killer Addiction

Trade name for Nalbuphine Hydrochloride is Nubain®.

Nalbuphine Hydrochloride (August 2011) Drug Enforcement Administration

Online Resources - Pain Management and Pain Killer Addiction

Academy of Pain Management and the Society for Pain Practice Management is an inclusive, interdisciplinary organization serving clinicians who treat people with pain through education, setting standards of care, and advocacy.

PainEDU.org Is an educational website for clinicians, teaching about pain assessment and management. This site is a comprehensive resource and is based on the latest scientific information about pain treatment.

Online Resources - Research and Pain Killer Addiction

Narcotic Analgesics in Brief (January 2003) shows figures on emergency department visits resulting from narcotic analgesic use. Drug Abuse Warning Network. The DAWN Report, Substance Abuse and Mental Health Services Administration (SAMHSA).

Nonmedical Users of Pain Relievers: Characteristics of Recent Initiates (2006) is a survey of pain killer use in the United States. National Survey on Drug Use and Health (NSDUH).

For additional research on painkiller addiction see the Analgesics/Pain Relievers section of the Office of Applied Studies website, Substance Abuse and Mental Health Services Administration (SAMHSA).

Online Resources - Screening for Pain Killer Addiction

The Screener and Opioid Assessemtn for Patients in Pain (SOAPP) is a brief paper and pencil tool to facilitate assessment and planning for chronic pain patients being considered for long-term opioid treatment.

Online Resources - Tramadol and Pain Killer Addiction

Tramadol also goes by trade names Ultram® and Ultracet®.

Tramadol (February 2011) Drug Enforcement Administration.

Online Resources - Vicodin and Pain Killer Addiction

See the Hydrocodone section above.

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III. VIDEO RESOURCES 

This video series is one man’s recommendations about how he stopped using pain killers:

Getting off Painkillers - Part 1
Part 2

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